五行音乐干预对重症监护病房撤机困难患者焦虑抑郁障碍和撤机成功率的影响  

Effects of Five-Element music intervention on anxiety and depressive disorders and successful rate of extubation in intensive care unit patients with difficult weaning

作　　者：魏珂 张文稳 冯光 忽新刚 Wei Ke;Zhang Wenwen;Feng Guang;Hu Xinguang(Nanyang Medical College,Nanyang 473000,Henan,China;Department of Public Health Development,Henan Provincial People's Hospital(Zhengzhou University People's Hospital),Zhengzhou 450000,Henan,China;Department of Neurosurgical Intensive Care Unit,Henan Provincial People's Hospital(Zhengzhou University People's Hospital),Zhengzhou 450000,Henan,China;Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital(Zhengzhou University People's Hospital),Zhengzhou 450000,Henan,China)

机构地区：[1]南阳医学高等专科学校,河南南阳473000 [2]河南省人民医院(郑州大学人民医院)公共事业发展部,郑州450000 [3]河南省人民医院(郑州大学人民医院)神经外科重症监护病房,郑州450000 [4]河南省人民医院(郑州大学人民医院)呼吸与危重症医学科,郑州450000

出　　处：《中华危重病急救医学》2024年第10期1044-1048,共5页Chinese Critical Care Medicine

基　　金：河南省医学科技攻关计划项目(SBGJ202002001)。

摘　　要：目的观察五行音乐干预对重症监护病房(ICU)撤机困难患者焦虑抑郁障碍和撤机成功率的影响。方法采用前瞻性随机对照研究方法,选择2019年1月至2021年1月河南省人民医院呼吸重症监护病房(RICU)收治的80例撤机困难伴焦虑抑郁障碍患者作为研究对象,并按随机数字表法分为观察组和对照组,每组40例。对照组给予常规呼吸康复治疗,每天评估脱机并逐步降低机械通气支持力度,直至撤机;观察组在常规呼吸康复治疗基础上加用五行音乐疗法,根据患者的临床表现,运用中医理论进行脏腑辨证,然后给予辨证施音,采用中国传统五行音乐(石峰作曲,中华医学电子音像出版社)进行干预治疗。记录患者性别、年龄、急性呼吸窘迫综合征(ARDS)病因、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等基线资料;使用12导联同步导联全息24 h动态心电图记录仪连续记录24 h及以上以R波为主的心电信号,计算心率变异性(HRV)指标〔全程正常窦性R-R间期标准差(SDNN)、全程5 min平均R-R间期标准差(SDANN)、全程差值超过50 ms的连续正常R-R间期百分比(PNN50)、全程相邻R-R间期差值的均方根(RMSSD)〕,同时记录HRV频域参数〔低频带(LF,0.05~0.15 Hz)、高频带(HF,0.16~0.50 Hz)及LF/HF比值〕;比较两组患者谵妄发生率、撤机成功率、7 d内二次插管率、ICU住院时间和住院病死率。结果对照组患者入组后有8例脱落,最终32例纳入分析;观察组40例患者均纳入分析。两组患者性别、年龄、ARDS病因及APACHEⅡ评分差异均无统计学意义,具有可比性。两组患者干预前HRV指标及HRV频域参数差异均无统计学意义;干预后,观察组患者HRV指标及HRV频域参数均较对照组显著升高〔SDNN(ms):77.21±11.75比63.81±13.50,SDANN(ms):83.51±19.45比50.40±14.55,PNN50:(10.75±3.42)%比(7.79±3.13)%,RMSSD(ms):47.15±6.57比31.74±6.37,HF(ms2/Hz):568.50±144.48比496.94±151.56,LF(ms2/Hz):840.Objective To investigate the effects of Five-Element music intervention on anxiety,depression,and weaning successful rate in intensive care unit(ICU)patients with difficult weaning.Methods A prospective randomized controlled trial was conducted.Eighty patients with difficulty in weaning accompanied by anxiety and depression disorders admitted to the respiratory intensive care unit(RICU)of Henan Provincial People's Hospital from January 2019 to January 2021 were enrolled as research subjects.They were divided into an observation group and a control group using a random number table method,40 cases in each group.The patients in the control group received routine respiratory rehabilitation treatment,with daily assessments of weaning and gradual reduction of mechanical ventilation support until weaning was achieved.The patients in the observation group received additional Five-Element music therapy,in addition to routine respiratory rehabilitation treatment.Based on the clinical manifestations of the patients and applying traditional Chinese medicine theory for syndrome differentiation,music therapy was applied accordingly.The intervention used traditional Chinese Five-Element music(composed by Shi Feng,published by China Medical Electronic Audio and Visual Publishing House).Baseline data including the gender,age,etiology of acute respiratory distress syndrome(ARDS),and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score of patients were recorded.A twelve-lead synchronous Holter monitor continuously recorded the R-wave dominant electrocardiogram signal for 24 hours or more.Heart rate variability(HRV)indices[standard deviation of all normal sinus R-R intervals(SDNN),standard deviation of 5-minute average R-R intervals(SDANN),percentage of continuous normal R-R intervals with differences greater than 50 ms(PNN50),and the root mean square of successive differences in adjacent R-R intervals(RMSSD)]were calculated,as well as HRV frequency domain parameters[low-frequency band(LF,0.05-0.15 Hz),high-frequency b

关 键 词：音乐疗法 机械通气 困难撤机 焦虑抑郁障碍 

分 类 号：R749[医药卫生—神经病学与精神病学]